How to get rid of the ulnar head

1. Dr. med. Camillo Müller
Centre de la Main
CHUV, Lausanne
Sauvé-Kapandji vs Darrach

3. Sauvé-Kapandji vs Darrach

4. 07/06/2016 44
• Bibliographie
INTRODUCTION
introduction
anatomy
biomechanic
arthrosis
comparison
Faut-il préférer l’intervention de Sauvé-Kapandji
à celle de Darrach en cas de pathologie de l’articulation
radio-ulniare distale?

5. 07/06/2016 55
• Bibliographie
INTRODUCTION
introduction
anatomy
biomechanic
arthrosis
comparison
Darrach
Sauve-Kapandji

6. 07/06/2016 66
• Bibliographie
INTRODUCTION
introduction
anatomy
biomechanic
arthrosis
comparison

7. 07/06/2016 77
• Bibliographie
ANATOMY
introduction
anatomy
biomechanic
arthrosis
comparison
http://link.springer.com/article/10.1007/s00113-012-2178-z

8. 07/06/2016 88
• Bibliographie
BIOMECHANIC
introduction
anatomy
biomechanic
arthrosis
comparison
https://en.wikipedia.org/wiki/Diva

9. 07/06/2016 99
• Bibliographie
BIOMECHANIC
introduction
anatomy
biomechanic
arthrosis
comparison
J Der Unfallchirurg V 115 N 7R 10.1007/s00113-012-2178-z Die Behandlung der Arthrose
des distalen Radioulnargelenks http://dx.doi.org/10.1007/s00113-012-2178-z

10. 07/06/2016 1010
• Bibliographie
BIOMECHANIC
introduction
anatomy
biomechanic
arthrosis
comparison
J Der Unfallchirurg V 115 N 7R 10.1007/s00113-012-2178-z Die Behandlung der Arthrose
des distalen Radioulnargelenks http://dx.doi.org/10.1007/s00113-012-2178-z

11. 07/06/2016 1111
• Bibliographie
ARTHROSIS
introduction
anatomy
biomechanic
arthrosis
comparison
J Der Unfallchirurg V 115 N 7R 10.1007/s00113-012-2178-z Die Behandlung der Arthrose
des distalen Radioulnargelenks http://dx.doi.org/10.1007/s00113-012-2178-z

12. 07/06/2016 1212
• Bibliographie
ARTHROSIS
introduction
anatomy
biomechanic
arthrosis
comparison
• Dégénérative / Posttraumatique /
Congénital
• Plaintes:
• dlrs: dorsales, charge transversal,
pro-supination
• observation: malposition,
tuméfaction ulnaire
• palpation: dlrs: dorsales DRUJ
• motricité: instabilité DRUJ
J Der Unfallchirurg V 115 N 7R 10.1007/s00113-012-2178-z Die Behandlung der Arthrose
des distalen Radioulnargelenks http://dx.doi.org/10.1007/s00113-012-2178-z

13. 07/06/2016 1313
• Bibliographie
ARTHROSIS
introduction
anatomy
biomechanic
arthrosis
comparison
• Rx: prodrome: DRUJ proximal:
ostéophytes
• CT- axial
J Der Unfallchirurg V 115 N 7R 10.1007/s00113-012-2178-z Die Behandlung der Arthrose
des distalen Radioulnargelenks http://dx.doi.org/10.1007/s00113-012-2178-z

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• Bibliographie
COMPARISON
introduction
anatomy
biomechanic
arthrosis
comparison
• Options thérapeutique:
• Darrach
• Bowers (hémi-resection)
• Watson (hémi-resection)
• Sauvé-Kapandji (arthrodèse RU)
• Prothèse tête ulnaire
J Der Unfallchirurg V 115 N 7R 10.1007/s00113-012-2178-z Die Behandlung der Arthrose
des distalen Radioulnargelenks http://dx.doi.org/10.1007/s00113-012-2178-z

15. 07/06/2016 1515
• Bibliographie
COMPARISON
introduction
anatomy
biomechanic
arthrosis
comparison
• Options thérapeutique:
• Darrach
• Bowers (hémi-resection)
• Watson (hémi-resection)
• Sauvé-Kapandji (arthrodèse RU)
• Prothèse tête ulnaire
J Der Unfallchirurg V 115 N 7R 10.1007/s00113-012-2178-z Die Behandlung der Arthrose
des distalen Radioulnargelenks http://dx.doi.org/10.1007/s00113-012-2178-z

16. 07/06/2016 1616
• Bibliographie
COMPARISON I
introduction
anatomy
biomechanic
arthrosis
comparison
24 specimens
1 control group (6)
2 ulnar-shortening (6)
3 Sauvé-Kapandji (6)
4 Darrach (6)
Ulnar impaction syndrome with different operative methods: a comparative biomechanical
study.Yu YD, Wu T, Tian FT, Shang YT, Yu XF, Bai YB, Han CL.Int J Clin Exp Med.
2015 Apr 15;8(4):5715-22. eCollection 2015.PMID: 26131156

17. 07/06/2016 1717
• Bibliographie
COMPARISON I
introduction
anatomy
biomechanic
arthrosis
comparison
24 specimens
1 control group (6)
2 ulnar-shortening (6)
3 Sauvé-Kapandji (6)
4 Darrach (6)
Ulnar impaction syndrome with different operative methods: a comparative biomechanical
study.Yu YD, Wu T, Tian FT, Shang YT, Yu XF, Bai YB, Han CL.Int J Clin Exp Med.
2015 Apr 15;8(4):5715-22. eCollection 2015.PMID: 26131156

18. 07/06/2016 1818
• Bibliographie
COMPARISON I
introduction
anatomy
biomechanic
arthrosis
comparison
pressure sensitive film
Ulnar impaction syndrome with different operative methods: a comparative biomechanical
study.Yu YD, Wu T, Tian FT, Shang YT, Yu XF, Bai YB, Han CL.Int J Clin Exp Med.
2015 Apr 15;8(4):5715-22. eCollection 2015.PMID: 26131156

19. 07/06/2016 1919
• Bibliographie
COMPARISON I
introduction
anatomy
biomechanic
arthrosis
comparison
pressure sensitive film
Ulnar impaction syndrome with different operative methods: a comparative biomechanical
study.Yu YD, Wu T, Tian FT, Shang YT, Yu XF, Bai YB, Han CL.Int J Clin Exp Med.
2015 Apr 15;8(4):5715-22. eCollection 2015.PMID: 26131156

20. 07/06/2016 2020
• Bibliographie
COMPARISON I
introduction
anatomy
biomechanic
arthrosis
comparison

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• Bibliographie
COMPARISON I
introduction
anatomy
biomechanic
arthrosis
comparison
Conclusions:
the ulnar-shortening superior to
Sauvé-Kapandji and Darrach procedure
Ulnar impaction syndrome with different operative methods: a comparative biomechanical
study.Yu YD, Wu T, Tian FT, Shang YT, Yu XF, Bai YB, Han CL.Int J Clin Exp Med.
2015 Apr 15;8(4):5715-22. eCollection 2015.PMID: 26131156

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• Bibliographie
COMPARISON II
introduction
anatomy
biomechanic
arthrosis
comparison
• retrospective study
• Darrach vs Sauve–Kapandji procedure
• Twelve patients in the Sauve–Kapandji
group Twenty-one of the Darrach
group
The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint
dysfunction after Colles' fracture. George MS, Kiefhaber TR, Stern PJ.J Hand Surg Br.
2004 Dec;29(6):608-13. PMID: 15542225

23. 07/06/2016 2323
• Bibliographie
COMPARISON II
introduction
anatomy
biomechanic
arthrosis
comparison
The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint
dysfunction after Colles' fracture. George MS, Kiefhaber TR, Stern PJ.J Hand Surg Br.
2004 Dec;29(6):608-13. PMID: 15542225

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• Bibliographie
COMPARISON II
introduction
anatomy
biomechanic
arthrosis
comparison
The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint
dysfunction after Colles' fracture. George MS, Kiefhaber TR, Stern PJ.J Hand Surg Br.
2004 Dec;29(6):608-13. PMID: 15542225
Grip strength lower in the Darrach than in the Sauve–Kapandji
not a statistically significant difference
There were no significant differences in the Modified Mayo Wrist
Scores.
78 in the Sauve–Kapandji group
72 in the Darrach group
The mean pain scores in the Modified Mayo
20 in the Sauve–Kapandji group
19 in the Darrach group

25. 07/06/2016 2525
• Bibliographie
COMPARISON II
introduction
anatomy
biomechanic
arthrosis
comparison
The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint
dysfunction after Colles' fracture. George MS, Kiefhaber TR, Stern PJ.J Hand Surg Br.
2004 Dec;29(6):608-13. PMID: 15542225

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• Bibliographie
COMPARISON III
introduction
anatomy
biomechanic
arthrosis
comparison
32 wrists in the S–K
31 wrists in Darrach
examined before and after surgery:
clinical evaluations of pain, swelling,
range of motion, grip strength, and
radiological findings
Comparison of the Sauvé-Kapandji procedure and the Darrach procedure for the
treatment of rheumatoid wrists. Nakagawa N, Abe S, Kimura H, Imura S, Nishibayashi Y,
Yoshiya S.Mod Rheumatol. 2003 Sep;13(3):239-42. doi: 10.3109/s10165-003-0229-6.

27. 07/06/2016 2727
• Bibliographie
COMPARISON III
introduction
anatomy
biomechanic
arthrosis
comparison
Comparison of the Sauvé-Kapandji procedure and the Darrach procedure for the
treatment of rheumatoid wrists. Nakagawa N, Abe S, Kimura H, Imura S, Nishibayashi Y,
Yoshiya S.Mod Rheumatol. 2003 Sep;13(3):239-42. doi: 10.3109/s10165-003-0229-6.

28. 07/06/2016 2828
• Bibliographie
COMPARISON III
introduction
anatomy
biomechanic
arthrosis
comparison
Comparison of the Sauvé-Kapandji procedure and the Darrach procedure for the
treatment of rheumatoid wrists. Nakagawa N, Abe S, Kimura H, Imura S, Nishibayashi Y,
Yoshiya S.Mod Rheumatol. 2003 Sep;13(3):239-42. doi: 10.3109/s10165-003-0229-6.

29. 07/06/2016 2929
• Bibliographie
COMPARISON III
introduction
anatomy
biomechanic
arthrosis
comparison
Comparison of the Sauvé-Kapandji procedure and the Darrach procedure for the
treatment of rheumatoid wrists. Nakagawa N, Abe S, Kimura H, Imura S, Nishibayashi Y,
Yoshiya S.Mod Rheumatol. 2003 Sep;13(3):239-42. doi: 10.3109/s10165-003-0229-6.

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• Bibliographie
COMPARISON: TAKE HOME
introduction
anatomy
biomechanic
arthrosis
comparison
STUDY I (1-0)
Sauvé-Kapandji: better postOP force
distribution (not significative)
STUDY II (2-1)
results show that the Darrach and Sauve–
Kapandji procedure yield comparable and
unpredictable results
STUDY III (3-1)
the S–K procedure is superior to the Darrach
procedure in reducing ulnar migration,and
improving grip

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Merci
Camillo Theo Müller, MD
@camillomueller